Apple Health (Medicaid) Benefit Changes 2014

Changes take effect at the beginning of 2014

Dental Services for Adults

Dental health benefits are being restored for individuals 21 years of age and older in January 2014. Now is a good time to call schedule an appointment. Make sure your dentist is enrolled as a Medicaid provider.

Mental Health Services Unlimited Number of Visits

In 2014, you’ll have no limits on the number of visits you can schedule for mental health services in a calendar year. You should be assessed by your mental health provider for appropriateness of place of service. If you meet the access to care standards you should always be referred to the Regional Support Network for an assessment and/or possible treatment.

Expanded Pool of Licensed Providers

While Psychiatrists are currently the sole mental health provider for adults, in January 2014, you will be able to obtain mental health services from a variety of providers, not just Psychiatrists. Coverage is expanding so you can receive services by Licensed Advanced Social Workers, Licensed Independent Social Workers, Licensed Mental Health Counselors, Licensed Marriage and Family Therapists and Psychologists. Make sure your provider is enrolled with Medicaid. As a reminder, children have had the ability to see any of the previously named types of mental health professionals (per a law passed in 2006).

Preventative Care Shingles Vaccine

In 2014, Apple Health shall will cover the shingles vaccination for clients 60 years of age and older. There is evidence from the Food and Drug Administration  that being of age 60 or older is the most effective time to receive the vaccine. Even if you’ve had shingles before, you may get it again.

Oral Contraception

Effective 2014, Apple Health will allow eligible clients the option to fill birth control prescriptions for a 12-month period. In 2013, clients can fill in one and three-month increments. It is the intent that by allowing for a year’s worth of contraceptives will provide a woman the assurance she has adequate coverage to prevent an unwanted pregnancy.

Early Intervention Screening for Substance Abuse

Apple Health will cover services provided by trained, certified medical providers who conduct screening, brief intervention, and referral for treatment for individuals who may present as facing challenges with substance abuse, including alcohol, drugs and tobacco. A great example would be if a person appears for medical care and the medical provider believes the illness or injury may be related to substance abuse, they might refer the patient to some community resources or other treatment. Training shall be provided over the next several years to medical providers who want to provide this service.

Screening of Children for Autism

Funding has been approved so that Apple Health’s enrolled primary care physicians can screen your child, if they are under three years of age to assess for autism. We are hopeful that more children will receive early screening and be referred to a Center of Excellence for further testing, as clinically indicated.

Licensed Naturopathic Physicians serving as Primary Care Doctors 

Another expansion of service in 2014 is that licensed naturopathic physicians are able to provide primary care services. Given there are a limited number of primary care physicians, individuals possessing a Washington Department of Health Naturopathic Physician license shall be able to provide care in the scope of care outlined by Department of Health, including diagnosing, administering vaccines and immunizations, provide referrals to specialists, conduct minor office procedures, and write limited Food and Drug Administration-approved prescriptions. If you are interested in having a naturopathic physician be your provider, you may conduct a search at https://fortress.wa.gov/hca/p1findaprovider/. Keep in mind, these physicians may not all have enrolled with Medicaid just yet, but hopefully the numbers will increase as the year progresses.

Vendors that Provide Wheelchairs and Accessories

In 2014, Apple Health will provide coverage of wheelchairs and accessories from vendors that are Medicare certified to provide Complex Rehabilitation Technology items. The vendor must have a technician to assure quality of service, with the expertise related to customization to suit the patient’s size and maximize the item’s functionality for that particular patient’s usage. Complex Rehabilitation Technology items serve patients with serious medical conditions, and Medicare recognizes the specialized nature of the Complex Rehabilitation Technology.